Commentary and repost: improving the birth experience

The midwife/home birth/virtue of crunchiness/feminist debate has surfaced again, and the talk seems to be centered (again) on the choice a woman makes between home birth (not very safe) and hospital birth (much safer, but still prone to complications). This debate never fails to get a rise out of me, because I don’t believe that a natural home birth with a midwife and a medicated hospital birth with an OB should be a choice that pregnant women have to make. I chose to have Monkey in a hospital because I believed that was best for him and me, and I’d make the same decision again. But I’d choose to deliver with the assistance of a certified nurse midwife instead of an OB. I’d listen to my nurse when she told me to wait longer before heading to the hospital, so that I could do most of my laboring in the comfort of my own home. I’d not have let them break my water to *speed things up*. And I’d try to deliver without the assistance of an epidural. (I wasn’t in pain and I stopped throwing up every minute, but I itched like a mutherfucker after they shot me up, leading to 7 hours of tossing and turning and scratching while hooked up to a machine that wouldn’t stop beeping. Try and get some sleep before it’s time to push… yeah right.)

Anyhow, I just read Kate Clancy’s take, a good source of information for individuals on either end of the spectrum, or those who are simply trying to dig through the noise. Also, if anyone’s interested, here’s what I wrote a few months ago:

I’m not one of those granola women who avoided hospitals and medical interventions during labor. But I was (and still am) a big believer that birth is a natural process, which sometimes gets treated like an illness by the medical profession. I chose to give birth to Monkey in a hospital, in case – God forbid – something happened, but I made it clear that I wanted Monkey’s birth to be as natural as possible. As a result of my preparedness and support system (a doula), interventions weren’t proposed until my labor stalled and I started asking questions. And I was offered an epidural only after muttering my safe word to Hubby (since breaking my water also led to hell breaking lose throughout my body). In spite of the fact things didn’t go the way I planned, I was clearly in charge of how I was treated during labor. And I like being in charge.

After Monkey was born and the doula left, that “in charge” feeling quickly faded. Monkey had trouble clearing out all of the fluid in his lungs and wasn’t crying as loudly as the nurses would have liked. So I barely had a chance to let him latch on to nurse before they took him away. For most of his first hours, I wasn’t allowed to hold my baby boy. Instead, he was in a crib surrounded by nurses and Hubby, where I could barely see him. It was upsetting, and I now wonder if this separation contributed to problems breastfeeding and postpartum depression. The next couple of days of my stay, I was bombarded by doctors, nurses, and a plethora of specialists, each directing me how to best take care of my baby, and some of whom were quite rude. In spite of their helicoptering and my constant requests, I was allowed to leave the hospital without being given the all-important TDaP vaccine. To say the least, I wasn’t impressed with the hospital experience at all, post-Monkey’s birth.

This past weekend, Hubby and I watched a documentary called “The Business of Being Born“, a scathing assessment of what was referred to as the birthing industry. I was uncomfortable watching it, partly due to the fact that Ricki Lake give birth in a bath tub (the images from which may never be wiped from my memory), and partly because home births were pushed so strongly. I believe properly-trained certified nurse midwives can direct many births, without the use of heavy medical interventions that often drive up the cost of delivery. And I don’t like how often cesarean sections occur, especially when due to convenience rather than medical necessity. But do we really want to go back to a time when women and newborn babies lacked the medical treatment they need?

IMO, there’s a more realistic solution that should be considered. We should depend more on certified nurse midwives, in hospitals, for uncomplicated pregnancies. And more hospitals should employ doulas, or some sort of support personnel, to guide women through the birthing process AND postpartum period. These measures are common in other countries, which (according to the documentary) have better rates of maternal and baby survival at much less cost. Furthermore, studies in the US have determined that the presence of a doula is correlated with less intervention and lower rates of cesarean section (ie, lower cost). In the midst of rising health care costs, this might be a good time to consider a safe, practical, and cost-effective middle ground for childbirth, if only we can remember how to compromise.

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11 thoughts on “Commentary and repost: improving the birth experience

  1. An excellent well argued post. I couldn’t agree with you more. I have only given birth once but was lucky enough to do so in a birthing center with midwives and OBs present. I had complications due to high blood pressure yet despite all the necessary medical interventions I was always offered options, choices were discussed with me or my spouse, and I felt, safe, taken care of, and HEARD. My decisions were respected and not argued with, nothing was done to me without my permission. Even the nurse who came in for a blood draw waited until I said I was ready.

    I was in the birthing center for three days and left with nothing but love and respect in my heart for all the people that worked there (doctors, nurses, and midwives). My experience shouldn’t be the outlier, it should be every woman’s experience of birth regardless of how natural, healthy, or complicated the the process is. I wish every woman had the option of a birthing center, it shouldn’t just be hospital or home.

  2. the either or and absoluteness of the discussion is stopping me from getting involved. I dont have the time or mental capacity for it. The discussion really should centre around how to improve the birth experience for moms and babies, minimizing unnecessary medical intervention.

    LOVE the new layout BTW

  3. I totally agree with you, like I did when you originally posted this.

    And I have been really put off recently by bloggers attacking women who have natural childbirths or have home-births. There are risks to everything and women should be given information on the full extent of those risks and allowed to make their own decisions about their bodies.

    I would vaguely understand if someone who was pro-life said that women should only be allowed to have hospital-based doctor births with no say of their own in the process. And maybe these bloggers are that pro-life, they don’t say. But I tend to doubt it.

    You are absolutely right that there is a good and safe solution to this problem: experienced midwives with expert OBs in the building on call in a medical setting. My mother had that when my sister was born almost 30 years ago. In my town midwives are not allowed in the hospital– they can *only* do home births. That is not a choice I should have to make. Making that available is where our ire and effort should focus, not on demonizing women who decide to opt out of the medicalized OB setting.

    From the availability heuristic perspective, more of us know people for whom something has gone horribly wrong at the hospital than in a home birth, just because most of us don’t know anybody who has had a home birth.

  4. I just can’t understand the logic of taking one extreme to combat another. (It’s the same thing happening in politics right now, completely irritating AND counterproductive.) Besides, as you point out, the number of women that opt for a home birth is not high at all, and the majority of them are doing it in response to this kind of crap.

    It would make a lot more sense to shift our target to something that actually IS a BIG problem – making hospital births more welcoming to a less intervening, more holistic process. In contrast to what others are indicating, there’s nothing *non-scientific* about this idea; in fact the data shows that support for the woman during the birthing process is a GOOD thing.

    Bottom line, there’s a battle to be fought, and the most influential spokespersons out there are fighting the wrong battle by pitting one extreme against another.

  5. Thanks for weighing in Dr. O! I’m so glad to hear another person with the balanced perspective of trying to listen to women, to understand the spectrum of beliefs women hold, and to trust that plenty of us actually weigh real evidence when making our decisions… whatever they may be.

  6. I agree. I don’t get why this has to be a choice between two extremes. I actually had a fairly good experience the second time around, despite the fact that I ended up with a C-section (surprise breech baby). And really, the only problem the first time around was that I was under-educated and my husband didn’t really know how to handle his usually assertive wife who wasn’t doing things according to plan. I had wonderful nurses and caring doctors and didn’t feel forced into any interventions. I had skin-to-skin contact with my baby right after birth the first time and as soon as medically advisible the second time- and heaps of support getting breastfeeding started. All of this in a hospital. A big one, at that.

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  8. Thank you for stopping by my humble blog :)

    I find this to be the most difficult part of blogging, in that extreme opinions seem so often to be countered with the opposite extreme. Attacking women who make a decision that I wouldn’t make for myself seems to be going too far, IMO.

  9. It’s funny, because I didn’t really have a BAD experience the first time around, but I would do things differently. And I think even big hospitals can be very nurturing when it comes to taking care of laboring women, many of the larger ones even providing *unorthodox* options, such as water births, midwives, etc… In places where these options haven’t become available (yet), I think is where you find more women going the homebirth route. I also think some in the medical and biomed research communities, take for granted the relative comfort we enjoy in a hospital setting.

  10. I don’t understand why there aren’t more birthing centers around for people to take advantage of. Even where I live, which is a fairly liberal community, most the centers are located further away from hospitals and don’t often have very many OBs on staff, making it a less desirable option for myself. I really wish the medical community as a whole would start embracing the idea of managing births in facilities like these…I think we’d see way fewer homebirths (than the small number we already see) if this option were more widely available.

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